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Published on: January 18, 2018
Rapid Aspiration Screening for Suspected Stroke: Part 1: Development and Validation
Stephanie K Daniels1, Shweta Pathak2, John C Rosenbek3
1Research Service Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Communication Sciences and Disorders, University of Houston, Houston, TX.
Objective:
To develop and validate a nurse-administered screening tool to identify aspiration risk in patients with suspected stroke.
Design:
Validity study comparing evidence-based swallowing screening items with the videofluoroscopic swallowing study (VFSS) results.
Setting:
A certified primary stroke center in a major metropolitan medical facility.
Participants:
Consecutive patients (N=250) admitted with suspected stroke.
Interventions:
Patients were administered evidence-based swallowing screening items by nurses. A VFSS was completed within 2 hours of swallowing screening.
Main Outcome Measures:
Validity relative to identifying VFSS-determined aspiration for each screening item and for various combinations of items.
Results:
Aspiration was identified in 29 of 250 participants (12%). Logistic regression revealed that age (P=.012), dysarthria (P=.001), abnormal volitional cough (P=.030), and signs related to the water swallow trial (P=.021) were significantly associated with aspiration. Validity was then determined on the basis of the best combination of significant items for predicting aspiration. The results revealed that age >70 years, dysarthria, or signs related to the water swallow trial (ie, cough, throat clear, wet vocal quality, and inability to continuously drink 90mL water) yielded 93% sensitivity and 98% negative predictive value.
Conclusions:
The final validated tool, Rapid Aspiration Screening for Suspected Stroke, is a valid nurse-administered tool to detect risk of aspiration in patients presenting with suspected stroke.
